COMING SOON: HEALTHCARE REFORM IN THE NEXT FOUR YEARS!

And that’s regardless of who becomes the next President. I don’t think I’m being overly optimistic since the signs are there.

The momentum that started with HIPAA, the escalating spiral of healthcare costs, and the fact that about one out of every six Americans does not have adequate health coverage have made healthcare reform a priority in the next administration.

According to the Commonwealth Fund, a New York-based private foundation whose mission is to promote a high-performing healthcare system:

In 2007, nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses).

(Losing Ground: How the Loss of Adequate Health Insurance is Burdening Working Families, August 2008)

Both Democrats and Republicans agree on the objectives but differ on the ways to achieve those objectives. Nevertheless the following bills are actively being legislated. They’re listed in the approximate order of their progress. A Senate bill is abbreviated as SB and a bill from the House of Representatives is abbreviated HR. Clicking on a link will open a new tab or window containing the PDF copy of the document.

SB 2408/HR 4295: The Medicare Electronic Medication and Safety Protection Act.

As it’s currently written, this act has both carrot and stick. On the one hand it encourages physicians to use e-prescriptions by offering a bonus payment equivalent to one percent of every claim submitted that is based on an e-prescription. On the other, it would impose a pre-claim financial penalty on physicians who still hand write prescriptions in 2011.

This bill was introduced in December 2007 by Senator John Kerry (D-Mass.) and co-sponsored by Republicans John Ensign (Nev.), Norm Coleman (Minn.), John Cornyn (Tex.), and fellow Democrats Charles Schumer (N.Y.), Richard Durbin (Ill.), and Maria Cantwell (Wash.).

HR 4296 is the House version of the former and is called the Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007.

It supplements HR 4295 by requiring physicians that participate in Medicare to e-prescribe.

HR 2991: The Independent Health Record Trust Act.

This could be the big one! It requires the national healthcare system to provide for the establishment of a nationwide health information technology network.

There are two more bills winding their way through the Senate and the House, respectively. These bills elaborate further on the need to develop a national interoperable health information network.

The Senate bill is SB 1693: The Wired for Healthcare Quality Act.

The House bill is HR 6357: PRO(TECH) Act of 2008: Promotion of Health Information Technology.

Finally, credit must also go to the federal government for actively working to develop the network of the future. Click here to see the program's status.

SHIFT PATTERNS

Scheduling work shifts is one of the most common and underestimated problems of modern organizations. It’s a vexing problem that can torpedo a system’s effectiveness. These are lessons learned from a recent project that needed a scheduling solution in order to be considered a success.

A department’s workload determines the shift patterns that it can adopt. Any scheduling decisions need to start with a clear understanding of the workload.

The workload needs to be converted into a number. This is the number of staff members that are needed to perform the workload. A level workload is easier to schedule than a seasonal or variable workload.

AREAS OF CONCERN

Scheduling difficulties always occur around holidays. After holidays the second most common area of concern is absences. The two remaining areas of concern are events that disrupt the staff from meeting the workload. These are training and breaks. Team training can be especially challenging. Breaks that occur due to staff fatigue will occur frequently in environments that have two or three shifts.

A significant difference exists between anticipated and unanticipated events. For example, many problems associated with training can be avoided by furnishing advance notice to the concerned staff. People generally dislike workplace surprises and they will appreciate any advance notice. Notification must be significant however. Being notified one, two, or three days is frequently inadequate. These notices are especially inadequate if the days span a weekend. Staff members will usually perceive this type of notice as last-minute maneuvers instead of advance notice.

HEALTHCARE-SPECIFIC CONCERNS

Horror stories abound about wrong limbs being amputated or procedures being performed on the wrong patients. When these cases of mistaken limbs or mistaken identities are investigated, a contributing factor is frequently miscommunication, or missed communication, between physicians or nurses who work in different shifts. The handover from one shift to the next is typically transmitted through written notes. Verbal information happens too infrequently, too randomly, and too incompletely to be considered unreliable.

The problem is exacerbated by two things. First is the mental and physical condition of the incoming shift worker. And second is the number and type of the incoming shift worker. Second- and third-shifts are usually populated with the more junior staff members. Among doctors these would be the new residents. Among nurses these would be the recent graduates. This situation means that the organization has less experience and less training at night. It’s a fair statement to make that from 5 pm to 7 am, most organizations have less of everything: less experienced and less trained workers and fewer of them at that. Conversely, it’s also fair to state that patients face more risk between those hours.

What can be done about this? Not much realistically. Statistics show that mortality rates are much higher during these hours. Patients can do their part by speaking up but too often patients are unable or unwilling to do that.

IMPLEMENTATION

After shift patterns have been created, the next step may either have the most problems or none at all. These extremes—problem-ridden or smooth sailing—will depend upon the terms and conditions of employment and the current state of labor relations. At many organizations, the terms and conditions of employment were written by people who are unfamiliar with the nuances of second- and third-shift conditions. Lawyers may work late into their evenings but I don’t know of any who work at 24 x 7 law firms. At many organizations, the current state of relations between management and rank-and-file dictates the ease or even possibility of implementing shift pattern problems. One can be repeatedly frustrated by these two issues. For example, common definitions may prevent any agreement. Days and weeks tend to have different connotations for second- and third-shift workers. Fortunately, or unfortunately, the prevalence of part-time workers sidesteps these two issues.

GENUINE CONSIDERATION LEADS TO EFFECTIVE SOLUTIONS

With all these said, the most important factor in solving shift-related problems is consideration. Shift patterns affect people’s lives. Genuine consideration for the impact that abrupt or excessive changes make to people’s lives goes a long way in creating suitable shift patterns.